tbuckley/cabot-search huggingface dataset:
Abstract 14068: Prospective Evaluation of Same-Day Discharge After Cryoballoon Ablation of AF: Results of the Easy-PVI Study
Authors: Emrie D Tomaiko-clark, Rong Bai, Robert M Sangrigoli, Ganesh Venkataraman, John D Harding, Wilber Su
Journal: Circulation (2021)

Introduction: With advancements in technology and techniques, catheter ablation for the treatment of atrial fibrillation (AF) has become safer with time. Historically, standard-of-care recommended overnight stay after procedure. With improved safety and shorter procedure times, some centers have allowed for same-day discharge (SDD). We report the results of a multi-center, randomized clinical trial investigating the safety of SDD after cryoballoon (CB) ablation of paroxysmal AF. Methods: Patients underwent pulmonary vein isolation (PVI) with the Medtronic Arctic Advance TM cryoballoon at 3 experienced U.S. centers. Six hours after procedure, patients were randomized to either stay overnight or be discharged same-day after meeting study inclusion criteria. Results: A total of 51 patients were enrolled. Two were determined to be screen-fails following ablation of extra-pulmonary foci. Final analysis encompassed the 46 patients who completed randomization and follow-up, with 23 randomized to each group. No significant adverse outcomes were reported in either group, defined as major cardiovascular or cerebrovascular events. Occurrence of any adverse events, including arrhythmia recurrence, vascular complication, ventricular arrhythmia, syncope, pacemaker implant, pulmonary vein stenosis, and persistent phrenic nerve palsy, did not differ significantly between the two groups (p=1.0). Four patients had symptomatic and/or documented recurrence of atrial arrhythmia, three of which were in the same-day discharge group. Two patients developed cough post-operatively, one from each group. One patient from the next-day discharge cohort was diagnosed with pneumonia &gt;2 weeks post-procedure. No patients from either group required emergency room visits due to delayed procedural-related complications. Conclusions: This is the first randomized trial to our knowledge examining the safety of SDD post CB ablation. Based on our results, SDD following CB ablation is a safe option following uncomplicated ablation for PVI. Operators should use their discretion in selecting patients for SDD.
Abstract 9748: Validation of a Brief Dietary Questionnaire for Use in Clinical Practice: Mini-EAT <sup>TM</sup>
Authors: Kyla Lara-Breitinger, Jose Medina Inojosa, Zhuo Li, Sarka Kunzova, Amir Lerman, Stephen Kopecky, Francisco Lopez-jimenez
Journal: Circulation (2021)

Introduction: Limited validated rapid dietary screening tools are available for patient use for actionable goal setting to improve health and reduce cardiovascular risk. The Healthy Index (HEI) Score measures compliance with the 2015-2020 Dietary Guidelines for Americans but requires completion of an extensive food frequency questionnaire (FFQ) to compute, which is time consuming and impractical. Hypothesis: A 19-item dietary survey that assesses consumption of common food groups known to affect health is correlated to the gold standard FFQ and HEI score and can be further reduced without affecting validity. Methods: An evidence-based 19-item Eating Assessment Tool (EAT™) of common food groups was created through literature review and expert consensus. We then conducted a cross-sectional survey of adult patients from a preventive cardiology clinic or cardiac rehabilitation and of healthy volunteers (n=628, mean age= 37 y, 76% women). Participants completed an online 156-item FFQ which was used to calculate the HEI score using standard methods. The association between each EAT™ question and HEI score category was analyzed by Kruskal-Walis test. Linear regression models were used to identify univariable and multivariable predictors for HEI score. The final model of Mini-EAT™ was validated by 5-fold cross validation. Results: The 19-item EAT™ had good correlation with the HEI (r=0.77) and was subsequently reduced to the 8 items independently predictive of the HEI score: fruits, vegetables, whole grains, refined grains, legumes/nuts/seeds, low-fat dairy, high-fat dairy, and sweets consumption, without affecting the predictive ability of the tool (r=0.76). Conclusions: Mini-EAT™ is an 8-item validated brief dietary screener that correlates well with a comprehensive FFQ. Future studies to test the Mini-EAT™’s validity in diverse populations and for development of clinical decision support systems to capture changes over time are needed.
Abstract 9604: Pulmonary Artery Systolic Blood Pressure Predicted From Cardiac MR Image Data Without Requiring Calibration; A Virtual RHC?
Authors: Mark Doyle, Geetha Rayarao, Roger Lacson, Nasir Hussain, Robert W Biederman
Journal: Circulation (2021)

Introduction: Despite decades of initiatives, assessment of absolute pulmonary arterial pressures (PAP) by CMR has remained an elusive goal. We introduce a means to predict the PAP from routine image data easily obtained by CMR. The image data is directly used to calculate the impedance between the LV and the aorta (IMP LV ) and between the RV and the main PA (IMP RV ) which are combined to predict PAP. Methods: Patients (n=33, 82% F), 51 ±12 yrs) with a diagnosis of (PHTN) underwent evaluation by CMR to assess the blood flow through the aorta and PA at the interface to the LV and RV, respectively. Phase velocity mapping flow data at single plane (acquisition time 2min) was used to calculate the previously described and validated impedance for the LV and RV: IMP LV and IMP RV . IMP was calculated using the formula:IMP = (end systolic ejection time) x (mean blood velocity) / (vessel diameter). Systolic PAP was measured during a right heart cath examination performed within one week of the CMR. A multiple linear regression model was generated to predict systolic PAP, with parameters retained with a significance &lt;0.05. Results: The parameters that best predicted the systolic PAP were IMP LV , IMP RV and the distance of the measured IMP LV from the center position of the data range of IMP LV (r = 0.69, p&lt;0.001), Fig 1. The standard major-axis line was fitted to the data (p&lt;0.001). Conclusions: This is the first demonstration of the utility of a CMR-measured left and right ventricular impedance value to directly predict systolic PAP. Critically, the correlation coefficient, identical to Echo, holds over a very wide physiologic range, and has never been demonstrated before by CMR. Of central importance is the distinguishing feature that no calibration of the data is required, thus, unlike typical Echo-derived estimates of PAP or newer implanted pressure monitors, no estimate of CVP or RAP is required. Thus, this is the first-in-man CMR demonstration of a virtual RHC.
Abstract 12855: Left Atrial Reservoir Strain is an Early Marker of Atrial Fibrosis in Cardiovascular Surgery Patients
Authors: Toshiaki Nakajima, Akiko Haruyama, Suguru Hirose, Hiroko Yazawa, Taira Fukuda, Hirohisa Amano, Shu Inami, Syotaro Obi, Takuo Arikawa, Ikuko Shibasaki, Masashi Sakuma, Shichiro Abe, Hirotsugu Fukuda, Teruo Inoue, Shigeru Toyoda
Journal: Circulation (2021)

Introduction: Atrial fibrosis plays an important role in atrial remodeling and the development of atrial fibrillation (AF). Left atrium (LA) strain (LAS) measured by two-dimensional speckle tracking echocardiography (2DS) has been reported to be a useful method to predict the degree of atrial fibrosis. Hypothesis: To investigate whether LAS is an early marker of atrial fibrosis in cardiovascular surgery patients. Methods: Conventional echocardiography and 2DS method were performed in 131 patients (53 AF, 78 sinus rhythm (SR)) including cardiac valve disease (MR, AS, and CABG et al.). The mRNA and microRNA expression were analyzed by real-time reverse transcription polymerase chain reaction (RT-PCR) in 59 cases in which LA tissues were removed from the appendage. Results: Left atrial reservoir strain (LASr) negatively correlated with left atrial volume index (LAVI), and E/e’ and positively correlated with LVEF, and left atrial conduit strain (LAScd). LASr was significantly lower, and LAVI was higher in AF group. The fibrosis-related (COL1A, COL3A1, TGFβ1) and peroxisome proliferator-activated receptor-α (PPARα)-related (PPARα, PGC1α, CPT1B) genes expression as a metabolic remodeling showed a positive association with atrial ANP mRNA expression level, reflecting atrial pressure and mechanical stretching. The expression level of COL1A and TGFβ1 mRNA was higher in AF group, compared with SR group. LASr, but not LAVI, negatively correlated with the expression of COL1A1, TGFβ1, and miR21. Multivariate regression analysis showed that LASr was an independent predictor of COL1A1, TGFβ1, or miR21 expression. The PPARα-related gene expression did not correlate with LASr, and LVEF in SR group, while they had a significant negative correlation with LVEF in AF patients. AF patients (LVEF&lt;58%) had higher expression level of the PPARα-related genes, compared with those (LVEF≥58%). Conclusions: Low LASr exhibits increased atrial fibrosis, and LASr is extremely useful as an early marker for predicting atrial fibrosis and consequently AF in cardiovascular surgery patients. Furthermore, in progressed AF patients, overexpression of PPARα signaling may play a role in atrial degeneration eventually to leading to heart failure.
Abstract 14041: The Association of Left Heart Pressures and Survival After Starting Veno-Arterial Extracorporeal Membrane Oxygenation for Cardiogenic Shock
Authors: Joseph Tonna, Craig Selzman, Filio Billia, Adriana Luk, David Baran, Wayne B Batchelor, Behnam N Tehrani, Qussay Marashly, Christos P Kyriakopoulos, Iosif Taleb, Tara Jones, Jose Nunez, E. Wilson Grandin, Navin K Kapur, Peter Rycus, Stavros G Drakos
Journal: Circulation (2021)

Introduction: Despite the ability to provide full hemodynamic support in patients with refractory cardiogenic shock (CS), a potential limitation is elevated intracardiac filling pressures from increased left ventricular afterload. There is a paucity of data regarding the correlation of left atrial pressures (LAP) with outcomes. Hypothesis: Our objective was to determine association between LAP and survival for patients with refractory CS after 24 hours of VA ECMO support. Methods: Cohort analysis among 10,906 patients ≥18yrs from the Extracorporeal Life Support Organization (ELSO) Registry (2015 - 2020), with refractory CS on VA ECMO. LAP values were defined as pulmonary capillary wedge pressure (PCWP) or pulmonary arterial diastolic pressure (PAD) values if PCWP was missing. The exposure was LAP values at 24 hours on VA ECMO support. Our primary outcome was survival to discharge. We used multivariate regression, adjusted for age, and the following pre-ECMO variables: PaO2/FiO2, pH, mean arterial blood pressure (MAP), and SCAI classification; and the following variables after 24 hours of support: pH, MAP; and year. Results: Median age was 57 [IQR,46; 65] years old and 31% were females. Thirty two percent (n=3,465) presented with acute myocardial infarction, 29% (n=3,112) with acute heart failure and 1% (n=965) with both etiologies. Invasive hemodynamic monitoring was measured in 33% (n=3608) of patients. Median LAP was 18mmHg [IQR,14; 23]. Every 1 mm Hg incremental of LAP on support was associated with lower survival (aOR 0.97 [95% CI 0.95 to 0.98]; p&lt;0.001), and 30% increase in duration of VA-ECMO support (beta-coeff 1.37 [95% CI 0.42 to 2.3]; p=0.005). Conclusions: Reduced LAP may be associated with higher adjusted hospital survival in patients with refractory CS on VA-ECMO. These findings merit further investigation and prospective validation to assess the relationship between hemodynamically tailored management and outcomes in this patient population.
Covid-19: Asymptomatic testing is “paused” in England’s hospitals and care homes
Authors: Elisabeth Mahase
Journal: BMJ (2022)

Covid-19: Asymptomatic testing is "paused" in England's hospitals and care homes Elisabeth MahaseRegular asymptomatic testing for covid-19 in hospitals, care homes, and hospices in England will be "paused" from 31 August, the Department of Health and Social Care has said.Testing will also be halted in prisons and detention centres, as well as in domestic abuse refuges and homelessness settings.However, symptomatic testing in all of these high risk settings will continue.The government has said that the move is due to "low" prevalence of covid-19.The UK Health Security Agency's chief medical adviser, Susan Hopkins, said, "Covid case rates and hospitalisations are on the decline, demonstrating the positive impact of the vaccines, which remain our best form of defence.The data from our surveillance shows prevalence is low and decreasing, and we will continue to monitor this data closely."The government has said that testing will remain in place for admissions to care homes and hospices and for transfers of immunocompromised patients to and within hospitals.The latest Office for National Statistics data estimate that around one in 40 people in England-nearly 1.5 million-tested positive for covid-19 in the week ending 8 August. 1 They also show that deaths this summer involving covid-19 (5043, 10 June to 12 August 2022) have been almost double those seen last summer (2624, 11 June to 13 August 2021). 2
Abstract 13888: Impact of Atrial Fibrillation Ablation on Recurrent Cardiovascular Hospitalizations
Authors: Amr F Barakat, Ann Canterbury, Suresh Mulukutla, Floyd W Thoma, ahmet sezer, Aditya Bhonsale, Krishna Kancharla, Andrew Voigt, N A Estes, Samir Saba, Sandeep Jain
Journal: Circulation (2021)

Introduction: Atrial fibrillation (AF) ablation has been shown to improve quality of life in AF patients, however, its impact on healthcare resource utilization is not well established. We sought to evaluate the impact of AF ablation on cardiovascular hospitalizations as a surrogate for resource utilization. Methods: We retrospectively included consecutive patients undergoing AF ablation at our multi-hospital healthcare system (2013 - 2020). Hospital admissions were assessed in the 12-month period preceding the ablation procedure (or from the time of AF diagnosis, if AF was diagnosed &lt;12 months before ablation), and up to 24 months post-ablation. In each patient, pre- and post-ablation hospitalization rates were compared using paired t-test. Results: We included 4,310 patients who underwent AF ablation in our hospital system. Mean age was 63 ± 10 years, 65.5% were males, and mean CHA2DS2-VASc was 2.1 ± 1.5. AF ablation was associated with a statistically significant reduction in the total number of hospitalizations (0.7 ± 1.9 admission per person-year pre-ablation vs. 0.3 ± 0.7 post-ablation, P&lt;0.001), total number of cardiovascular hospitalizations (0.7 ± 1.2 admission per person-year pre-ablation vs. 0.2 ± 0.6 post-ablation, P&lt;0.001), total number of AF-related hospitalizations (0.6 ± 1.1 admission per person-year pre-ablation vs. 0.1 ± 0.4 post-ablation, P&lt;0.001), and total number of hospital admission days (2.2 ± 4.8 days per person-year pre-ablation vs. 1.3 ± 4.9 post-ablation, P&lt;0.001). The percentage of patients who had a cardiovascular hospitalization during each quarter (3-month period) of the pre- and post-ablation study period are shown in the Figure. Conclusions: In a large multi-hospital US healthcare system, AF ablation was associated with a significant reduction in the rates of hospitalization, including total, cardiovascular and AF-related hospitalizations, which may have significant implications for healthcare resource utilization.
Abstract 12208: Ecological Analysis of the Temporal Trends in the Association of Social Vulnerability and Race/Ethnicity With County-Level COVID-19 Incidence and Outcomes in the United States
Authors: Shabatun Islam, Aditi Nayak, Yingtian Hu, Anurag Mehta, Katherine Dieppa, Zakaria Almuwaqqat, Yi-An Ko, Shivani Patel, Abhinav Goyal, Samaah Sullivan, Tene Lewis, Viola Vaccarino, Alanna A Morris, Arshed A Quyyumi
Journal: Circulation (2021)

Background: The COVID-19 pandemic adversely affected socially vulnerable and minority communities in the US initially, but the temporal trends during the year-long pandemic remain unknown. Objective: We examined temporal association between county-level Social Vulnerability Index (SVI), a percentile-based measure of social vulnerability to disasters, its subcomponents and race/ethnic composition with COVID-19 incidence and mortality in US in the year starting in March 2020. Methods: Counties (n=3091) with &gt; 50 COVID-19 cases by March 6th, 2021 were included. Associations between SVI (and its subcomponents) and county level racial composition with incidence and death per capita were assessed using a negative-binomial mixed-effects model. This model was used to examine potential time varying associations between weekly number of cases/deaths and SVI or racial composition. Data was adjusted for percentage of population aged ≥65 years, state level testing rate, county-level comorbidities, and environmental factors. Results: Higher SVI, indicative of greater social vulnerability, was independently associated with higher COVID-19 incidence (adjusted incidence rate ratio [IRR] per-10 percentile increase:1.02, (95% CI 1.02, 1.03, p&lt;0.001), and death per capita (1.04, (95% CI 1.04, 1.05, p&lt;0.001). SVI became an independent predictor of incidence starting from March 2020, but this association became weak or insignificant by winter, a period that coincided with sharp increase in infection rates and mortality, and when counties with higher proportion of White residents were disproportionately represented (“third wave”). By Spring 2021, SVI was again a predictor of COVID-19 outcomes. Counties with greater proportion of Blacks also observed similar temporal trends in COVID-19-related adverse outcomes. Counties with greater proportion of Hispanics had worse outcomes throughout the duration of the analysis. Conclusion: Except for winter “third wave” when majority White communities had highest incidence of cases, counties with greater social vulnerability and higher minority populations, experienced worse COVID-19 outcomes.
Abstract 8958: Cystatin C is Superior to Creatinine in Risk Prediction After Transcatheter Aortic Valve Replacement
Authors: Kensuke Kuwabara, Kan Zen, Masaki Yashige, Kazuaki Takamatsu, Nobuyasu Ito, Yoshito Kadoya, Michiyo Yamano, Tetsuhiro Yamano, Takeshi Nakamura, Hitoshi Yaku, Satoaki Matoba
Journal: Circulation (2021)

Introduction: Cystatin C is an alternative marker of renal function less influenced by age, sex, race, and muscle mass compared with creatinine. No data has been reported about the prognostic meaning of chronic kidney disease classification by cystatin C-based estimated glomerular filtration rate (CKD Cys classification) in patients undergoing transcatheter aortic valve replacement (TAVR). Objective: The aim of this study was to compare the prognostic value of CKD Cys classification and classification by creatinine-based estimated glomerular filtration rate (CKD Cr classification) in the risk prediction after TAVR. Methods: We retrospectively analyzed consecutive 219 patients with symptomatic severe aortic stenosis who underwent TAVR in our institute between December 2016 and June 2019. Preoperative CKD Cys classification and CKD Cr classification were evaluated for their prognostic value of 2-year major adverse cardiovascular and cerebrovascular event (MACCE) after TAVR. MACCE was defined as the composite of all-cause mortality, myocardial infarction, cerebrovascular events, and rehospitalization for worsening congestive heart failure. Results: There were 59 MACCEs during the median follow-up period of 575.5days. CKD Cys classification not CKD Cr classification significantly stratified the risk of 2-year MACCE in patients after TAVR by log-rank test (P=0.002) (Figure 1). In multivariate Cox regression analysis, only CKD Cys classification stage 3b (hazard ratio=4.37; 95% confidence interval: 1.28 to 14.91; P=0.019) and CKD Cys classification stage4+5 (hazard ratio=3.72; 95% confidence interval: 1.06 to 12.99; P=0.040) were the independent predictors for MACCE after adjustment for potential confounders. Conclusions: The use of CKD Cys classification could provide better risk assessment than CKD Cr classification in patients undergoing TAVR. CKD Cys classification stage3b and stage4+5 correlated with adverse outcomes.
Abstract 13880: Autoimmune Connective Tissue Diseases and Cardiac Surgery
Authors: Sandro Sponga, Veronica Ferrara, Francois Dagenais, Nunzio Davide de MANNA, Andriy Dralov, Andrea Lechiancole, Igor Vendramin, Ugolino Livi, Pierre Voisine
Journal: Circulation (2021)

Introduction: The results of cardiac surgery in patients affected by autoimmune connective tissue diseases (ACTD) have not been extensively reported. Accordingly, we sought to assess the outcomes of ACTD patients after cardiac surgery, focusing on postoperative complications and survival at short and long term. Methods: Since 2008, 1002 cardiac surgical patients affected by ACTD (rheumatoid arthritis (RA) 59%, autoimmune vasculitis 14%, autoimmune inflammatory disease 12%, psoriatic arthritis 9%, and systemic lupus erythematosus (SLE) 6%), were retrospectively analysed in two centres. Demographics, clinical characteristics and specific treatment were recorded. Type of surgery, postoperative complications, early and late mortality were analysed. Results: Median age was 71 (22-92) years, and 48% were female. Most patients presented severe comorbidities (shown in the table) and required urgent surgery in 17% of cases, most frequently CABG (56%). Perioperative mortality was 2% but 60% of patients developed postoperative complications (mainly acute renal failure 15%). Patients affected by systemic inflammatory autoimmune diseases needed longer time of mechanical ventilation (p&lt;0.01), while those with vasculitis more frequently had pneumonia (p=0.05). SLE patients had higher 30-day mortality (7%, p=0.04). Survival at 1, 5 and 10 years was 97±1%, 82±1% and 59±2%, respectively, and most common causes of death were not cardiac related (75%). By multivariate analysis, RA (HR 1.30, 1.00-1.70) was a risk factor for late mortality while both SLE and vasculitis were risk factors for re-operation (p=0.04 and p&lt;0.01, respectively), at a median follow up of 59 months (1-184). Conclusions: Cardiac surgery in ACTD patients can achieve satisfactory short- and long-term results despite higher rate of postoperative complications, mainly renal failure and infections.